Minnesota Medicaid providers caught up in fraud crackdown
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Advocates say thousands of legitimate Medicaid service providers are getting swept up in Minnesota's fraud crackdown.
Why it matters: Many of these companies and nonprofits provide critical support for Minnesotans who rely on government-funded programs for autism, mental health and disability services.
Driving the news: State officials disclosed this week they will disenroll 3,411 providers following a request from the federal government to "revalidate" all 5,000 providers across 13 programs deemed at high risk of fraud.
- Just 59 of those were referred for fraud investigation, per the Department of Human Services.
Threat level: Many Medicaid service providers operate on small margins, advocates say, so even a temporary pause in reimbursements from the government can create big issues.
- "Essentially all of our revenue has been disrupted," Jordan Hansen, an addiction recovery services specialist who says he was wrongly disenrolled, told MPR News.
Hansen, who plans to appeal the decision, said he can't figure out where to send his patients for immediate care, given that so many other providers he knows were also removed.
The big picture: The stakes were high for the state, too: The federal government is threatening to withhold billions in critical funding over concerns of widespread fraud in the programs.
- The scramble to revalidate all 5,000 providers was seen as key to keeping that funding flowing.
What they're saying: "The most important goal for us is that Minnesotans deserve to have confidence in the providers that are enrolled in Medicaid," Department of Human Services deputy commissioner Shireen Gandhi told the Star Tribune, citing "tremendous pressure" from the federal government.
- She noted that providers who appeal the state's decision can be reapproved quickly once they submit the proper paperwork.
Yes, but: Critics of DHS' approach say it's causing unnecessary "chaos."
- "In the name of finding a small percentage of dishonest providers, they are disrupting a major portion of the system for the individuals who can least afford their system to be disrupted," state Sen. Jim Abeler (R-Anoka) told the paper.
The other side: State Rep. Kristin Robbins (R-Maple Grove), chair of the House's fraud prevention committee, said the "astonishing and problematic" rate of providers that failed to meet the requirements "shows the complete failure of management and internal controls that has been going on for years" under DHS' watch.
- "Without this revalidation requirement by [the federal Centers for Medicare and Medicaid Services], we would still be shoveling millions of taxpayer dollars out the door without knowing if providers were qualified or actually providing services being billed for," she said in a statement.
Between the lines: DHS, which conducted site visits and took other efforts to verify whether providers were legitimate, says the vast majority of those impacted (2,491) had submitted "incomplete or inaccurate administrative data."
- Over 900 failed site visits and about 100 had already stopped providing services, the agency's data shows.
Plus: In some cases, the process surfaced serious issues, such as licensed specialists saying they didn't actually work for providers that claimed to employ them.
Yes, but: Some providers say they never got a site visit or weren't told what paperwork was missing as DHS rushed to get the job done, per MPR.
What's next: Over 800 of the groups removed from the rolls had submitted appeals as of midweek, the Strib reports.